[1]杨川,勾俊龙,毛群**,等.立体定向手术治疗基底核区高血压性脑出血手术时机的探讨[J].中国微创外科杂志,2017,17(08):710-713.
　Yang Chuan,Gou Junlong,Mao Qun,et al.Clinical Research on Time Window of Stereotactic Surgery for Basal Ganglia Hypertensive Cerebral Hemorrhage[J].Chinese Journal of Minimally Invasive Surgery,2017,17(08):710-713.
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立体定向手术治疗基底核区高血压性脑出血手术时机的探讨()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年08期
页码:
710-713
栏目:
临床研究
出版日期:
2017-08-20

文章信息/Info

Title:
Clinical Research on Time Window of Stereotactic Surgery for Basal Ganglia Hypertensive Cerebral Hemorrhage
作者:
杨川; 勾俊龙; 毛群**; 刘宗惠①
天津市第三中心医院分院神经外科，天津300250
Author(s):
Yang Chuan;  Gou Junlong;  Mao Qun;  et al.
Department of Neurosurgery, Tianjin Third Central Hospital, Tianjin 300250, China
关键词:
基底核区高血压性脑出血; 立体定向手术; 手术时机
Keywords:
Basal ganglial hypertensive cerebral hemorrhage; Stereotactic surgery; Optimal timing of surgery
文献标志码:
A
摘要:
目的探讨立体定向血肿抽吸置管引流术治疗基底核区高血压性脑出血的手术时机。方法2003年1月~2016年1月我科采用立体定向手术治疗基底核区高血压脑出血135例，根据发病后手术时间不同分为超早期组（≤7 h）45例，早期组（7~24 h）45例，延期组（24~72 h）45例，比较3组术后血肿清除时间，30 d病死率，30 d患侧肢体运动功能和90 d格拉斯哥结果评分（Glasgow outcome score，GOS）。结果超早期组与早期组比较，超早期组血肿清除时间短［(4.5±0.8)d vs. (4.9±1.0)d，q=2.860，P<0.05］，术后30 d患肢肌力4~5级优于早期组［82.2%(37/45) vs. 62.2%(28/45)，Z=-5.572，P=0.000］，90 d GOS 5分者优于早期组［88.9%(40/45) vs. 71.1%(32/45)，Z=-6.836，P=0.035］。超早期组与延期组比较，超早期组血肿清除时间短［(4.5±0.8)d vs. (5.3±1.0)d，q=5.721，P<0.05］，术后30 d患肢肌力4~5级者优于延期组［82.2%(37/45) vs. 40.0%(18/45)，Z=-5.566，P=0.000］，90 d GOS 5分者优于延期组［88.9%(40/45) vs. 489%(22/45)，Z=-6.771，P=0.000］。早期组与延期组比较，早期组血肿清除时间短［(4.9±1.0)d vs. (5.3±1.0)d，q=2.860，P<0.05］，治疗30 d患肢肌力4~5级者优于延期组［62.2%(28/45) vs. 40.0%(18/45)，Z=-2.073，P=0.038］，90 d GOS 5分者优于延期组［71.1%(32/45) vs. 48.9%(22/45)，Z=-3.595，P=0.000］。结论立体定向手术治疗基底核区高血压性脑出血最佳手术时机在7 h内。
Abstract:
ObjectiveTo investigate the clinical efficacy of stereotactic surgery for basal ganglia hypertensive cebral hemorrhage at different time windows. MethodsAccording to the time window of surgery, a total of 135 patients with basal gannglia hypertensive cebral hemorrhage were divided into three groups, including ultraearly group (n=45, surgery started within 7 h), early group (n=45, surgery started between 7-24 h), and delayed group (n=45, surgery started between 24-72 h). The differences in the hematoma clearance time, the 30day mortality rate and motor function of the paralytic limbs, and the 90day Glasgow outcome scores (GOS) were compared among the three groups. ResultsAs compared to the early group, the ultraearly group had shorter hematoma clearance time ［(4.5±0.8) d vs. (4.9±1.0) d, q=2.860, P<0.05］, higher rate of diseased limb muscle of grade 4-5 on the 30th day ［82.2% (37/45) vs. 62.2% (28/45), Z=-5.572, P=0.000］, and higher rate of GOS scores of 5 points on the 90th day ［88.9% (40/45) vs. 71.1% (32/45), Z=-6.836, P=0.035］. As compared to the delayed group, the ultraearly group had shorter hematoma clearance time ［(4.5±0.8) d vs. (5.3±1.0) d, q=5.721, P<0.05］, higher rate of diseased limb muscle of grade 4-5 on the 30th day ［82.2% (37/45) vs. 40.0% (18/45), Z=-5.566, P=0.000］, and higher rate of GOS scores of 5 points on the 90th day ［88.9% (40/45) vs. 48.9% (22/45), Z=-6.771, P=0.000］. As compared to the delayed group, the early group had shorter hematoma clearance time ［(4.9±1.0) d vs. (5.3±1.0) d, q=2.860, P<0.05］, higher rate of diseased limb muscle of grade 4-5 on the 30th day ［62.2% (28/45) vs. 40.0% (18/45), Z=-2.073, P=0038］, and higher rate of GOS scores of 5 points on the 90th day ［71.1% (32/45) vs. 48.9% (22/45), Z=-3.595, P=0000］.ConclusionThe optimal timing of stereotactic surgery for basal ganglia hypertensive cerebral hemorrhage is within 7 hours.

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备注/Memo

备注/Memo:
基金项目：天津市卫生局基金课题（07KZ40）**通讯作者， Email：qunmao@hotmail.com ①（中国人民解放军海军总医院神经外科，北京100037）
更新日期/Last Update: 2017-11-22